Healthcare Provider Details

I. General information

NPI: 1790760049
Provider Name (Legal Business Name): MATTHEW S. WOLINS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2005
Last Update Date: 07/03/2022
Certification Date: 07/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8245 BOONE BLVD STE 210
VIENNA VA
22182-3875
US

IV. Provider business mailing address

10401 OLD GEORGETOWN RD SUITE 408
BETHESDA MD
20814-1911
US

V. Phone/Fax

Practice location:
  • Phone: 301-658-2019
  • Fax: 301-658-2018
Mailing address:
  • Phone: 301-658-2019
  • Fax: 301-658-2018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberD0054682
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207RB0002X
TaxonomyObesity Medicine (Internal Medicine) Physician
License NumberD54682
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberD54682
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: